CHAPTER TWO

ANALYSIS OF DATA
Analysis of data is the second step of the nursing process. It includes comparison of results of

the various diagnostic investigations carried out on Child. B.K.N with the normal values,

causes of Child. B.K.N’s condition, comparison of normal clinical features in literature

review with signs and symptoms presented by the patient, specific treatment given to patient,

pharmacology of drugs administered to patient, complications of the patient condition, patient

and family strength, patient’s health problem and nursing diagnosis.

COMPARISON OF DATA WITH STANDARDS

Data collected was compared to the standard in the textbooks. These included diagnostic tests

and investigations, causes, clinical manifestations, treatments and complications.

DIAGNOSTIC INVESTIGATIONS
Diagnostic test is a procedure that is done to detect the presence or absence of a particular

genetic alteration or allele to identify or confirm a diagnosis of a disease or condition. The

following investigations are requested per literature:

 Rapid diagnostic test

 Full blood count

 Blood film for malaria parasite

 Hemoglobin electrophoresis

 Urinalysis

 Chest x-ray

 Erythrocyte sedimentation rate Serum electrolytes

 Pulmonary function test

 Blood cultures
In addition to the diagnostic test done, history taking and physical examination was also

done. Diagnostic investigations are useful to the clinicians in establishing the cause of the

condition, including alteration in normal body functioning which could possibly contribute to

the disease condition so that diagnoses could be confirmed and planned for appropriate

intervention. The following laboratory investigations were done for Child. B.K.N;

 Full blood count

 Urine R/E

 Blood Grouping and Cross Matching

 Blood film for malaria parasites

 Serology

Comments on Patient’s Diagnostic Test

Child. B.K.N. did four out of the nine tests presented in literature. He did not undergo any

form of imaging studies

CAUSE
It is a hereditary disease and it occurs when a person inherits a sickle cell gene from either

parent.
Table 1: DIAGNOSTIC INVESTIGATIONS DONE FOR CHILD. B.K.N

DATE SPECIMEN INVESTIGATIONS RESULTS REFERENCE INTERPRETATION REMARKS

VALUES
02/12/202 Blood Full Blood Count with 3.8g/dl 11.5-16.0g/dl Low, indicating anaemia 3 pints of Blood

0 emphasis on: group O-positive was

 Haemoglobin prescribed and

administered
02/12/202 Blood White blood cell count 9.62k/UL 4.00-10.00k/UL Within normal range No treatment given

0 indicating absence of

infection
02/12/202 Blood Red blood cell 1.25m/UL 3.85-5.20m/UL Low, indicating anaemia 3 pints of Blood

0 group O-positive was

prescribed and

administered
02/12/202 Blood Platelet 150k/UL 140-440k/UL Within normal range No treatment given

0
02/12/202 Blood Blood film for malaria Malaria Malaria parasites No evidence of malaria No anti-malarial drug

0 parasites parasites not must be absent in parasite seen indicating was administered

seen the blood no malaria

02/12/202 Blood Blood grouping and Blood group O Blood group should Patient’s blood group was 3 pints of Blood

0 cross Matching with rhesus be A, B, AB, O O with rhesus factor D group O-positive was

factor D with rhesus factor (positive) prescribed and

(positive) either negative or administered

positive
02/12/20 Urine Glucose Negative Negative No indication for No treatment ordered
Protein Negative Negative
Leucocyte Negative Negative infections
Ketones Negative Negative
Blood Negative Negative
Nitrite Negative Negative
Bilirubin Negative Negative
pH 5.0 5-7
Specific gravity 1.015 1.010-1.030
STATEMENT OF COMPARISONWith reference to literature review, DIAGNOSTIC
TEST DONE GIVE AN INDICATION THAT PATIENT HAD CRISIS IN SICKLE CELL
DISEASE.

Treatment given to Child. B.K.N.

Treatment is the management and care of a patient to combat disease or disorder. It could be

either pharmacological or non-pharmacological.

Pharmacological treatment given to Child B.K.N.

IV Paracetamol 300mg tds for 3days

IV Ciprofloxacin 400mg bd for 3days

IVF Dextrose Normal Saline 500mls for a 24hours

IVF Normal Saline 3 litres for 2days

NON-PHARMACOLOGICAL TREATMENT GIVEN TO CHILD B.K.N.

a. Warm compress and massage were applied to the leg to relief the pain

b. Bed rest was ensured

c. Good nutrition was also encouraged

d. Patient was engaged in diversional therapy

TABLE 2: PHARMACOLOGY OF DRUGS ADMINISTERED TO CHILD. B.K.N

Date Drugs Dosage and route Classification Desired effect Actual effects Side effects and remedies
of administration observed
02/12/20 IV Normal 3 litres for 2 days Isotonic For hydrating Patient gained Oedema, fluid volume
Saline Intravenous Fluid patient to ensure strength indicating overload, air embolism and
adequate blood adequate blood heart failure.
circulation circulation None was observed
02/12/20 IV 300mg tds for Non-narcotic Relieves pain and Patient was relieved Haematocrit, rash, anaemia,
analgesics reduces fever of pain and had hypoglycaemia. None was
Paracetamol 3days
relaxed facial observed
expression
02/12/20 IV 400mg bd for Antibacterial and Bactericidal No infection was Dizziness, rash, nausea,
3days
Ciprofloxacin antibiotic agent action against observed vomiting,

gram-positive depression.

organism None of the above

02/12/20 IVF Dextrose 500mls for a Infusion nutrition 1.To replace fluid 1. Patient was Pulmonary oedema,
(carbohydrate) loss rehydrated. glucosuria, heart failure,
24hours
Normal Saline 2.To provide 2. she got energy osmotic diuresis, confusion
3.she regained her None was observed
energy
strength
STATEMENT OF COMPARISON

With reference to literature review, the drugs prescribed for the patient indicates that patient

had crisis in sickle cell disease.

Clinical Manifestation
Clinical manifestations are the signs and symptoms that a patient presents and they can be

determined through history taking, observation and examination of patient. The table below

shows the comparison of clinical features exhibited by Child. B.K.N. with literature.

TABLE 3: COMPARISON OF CLINICAL MANIFESTATION WITH LITERATURE

LITERATURE REVIEW PATIENT CLINICAL MANIFESTATION

Anaemia Patient was not anaemic

Jaundice Patient was not jaundiced

Tachycardia Patient had no tachycardia

Cardiac murmurs Patient had no cardiac murmurs

Headache Patient had headache

Swelling of the feet Patient had no swollen feet

Fever and chills Patient had fever and chills

Joint pains Patient experienced pains in the joints

Anorexia Patient had anorexia

General malaise Patient complained of general body weakness

Dehydration Patient was slightly dehydrated

Chest pains Patient had no chest pains

Difficulty in breathing Patient had no difficulty in breathing

Profuse sweating Patient did not experience it

STATEMENT OF COMPARISON ON CLINICAL FEATURES WITH
LITERATURE:
Per comparison Child. B.K.N. showed seven (5) out of fourteen (14) of the clinical

manifestation in literature which made it possible for his diagnosis.

STATEMENT OF COMPARISON OF COMPLICATIONS WITH LITERATURE

With reference of complications of sickle cell disease stated in the literature review Child.

B.K.N. did not experience any of the complications during the period of interaction.

Patient/Family Strengths
Patient and family strengths are those abilities, behaviors or attitudes that the patient or

family exhibit which are favorable for specified nursing interventions and also positively

affect treatment outcomes. The strengths identified in Child. B.K.N. and his family are as

follows:

1. Patient could verbalize intensity of pain.

2. Patient tolerated tepid sponging.

3. Patient and family cooperated with treatment.

4. Patient could drink water and tolerate food served in bits.

5. Patient could perform activities of daily living with assistance.

6. Patient could sleep at least two hours in the day.

7. Patient could communicate cheerfully with health care team.

PATIENT Health Problems

Health problems are the conditions that causes adverse effect to the health of the client. These

affect the client physically, socially, emotionally, and psychologically making his

incapacitated to function properly.

These included:

2nd December, 2020

1. Patient complained of left leg pain.

2. Patient had fever with a temperature of 38.1 degree Celsius.

3. Patient complained of headache.

3rd December, 2020

4. Patient complained of bitter taste in mouth.

4th December, 2020

5. Patient complained of weakness.

5th September, 2020

6. Patient complained of not sleeping well throughout the night.

6th September, 2020

7. Patient was anxious.

NURSING DIAGNOSIS
A nursing diagnosis is a clinical judgment concerning human response to health

conditions/life processes, or a vulnerability for that response, by an individual, family, group,

or community.

2nd December, 2020

1. Acute pain (left leg) related to intravascular occlusion.

2. Hyperthermia (above normal, 38.1 degrees Celsius) related to increased metabolic

rate.

3. Headache related to reduced blood flow to the brain.

 3rd December, 2020

4. Risk for Imbalanced nutrition (less than body requirement) related to inadequate food

intake secondary to bitter taste in the mouth.

4th December, 2020

5. Activity intolerance related to general body weakness.

5th December, 2020

6. Insomnia related to unfamiliar ward environment.

6th December, 2020

7. Anxiety related to hospitalization

 CHAPTER THREE

PLANNING FOR PATIENT/FAMILY CARE

Planning is the third phase of the nursing process. According to American Nurses association,

it involves setting measurable and achievable short- and long-range goals based on

assessment and diagnosis previously made. The nurse and the patient together consider the

goals to achieve in meeting the patient’s identified problems in daily life and produce an

individual care plan. The plan directs the activities of nursing staff in the provision of care. It

consists of nursing diagnosis, expected outcome criteria, nursing orders, intervention and

evaluation of the implemented care. It serves as a tool for documenting all aspects of the plan

of care. It therefore serves as a communication link between health care providers. The

objective/outcome criteria for the identified problems outlined are as follows;

Objective/Outcome Criteria

2nd December, 2020

1. Patient left leg pain will be reduced within 2 hours as evidenced by;

a. Patient verbalizing a reduction in pain with the pain reducing from 10 to 3

using a numeric pain scale

b. Nurse observing patient has a calm and relaxed facial expression in bed.

2. Patient’s body temperature will be reduced within 1 hour as evidenced by;

a. Patient verbalizing that his body is no longer warm to touch

b. Nurse monitoring patient vital signs especially temperature to ensure that it

has reduced.

3. Patient’s headache will be reduced within 1 hour as evidenced by;

a. Patient verbalizing pain has reduced.

b. Nurse observe patient has a calm and relaxed facial expression in bed.
3rd December, 2020

4. Patient will be remaining free from nutritional imbalances within 48 hours as

evidenced by;

 Patient maintaining his weight on admission (25kg).

 Nurse observing patient consume more than half of nutritious meal served.

4th December, 2020

5. Patient will be able to perform activities of daily living by himself within 48 hours as

evidenced by;

a. Patient verbalizing ability to perform activities of daily living.

b. Nurse observe patient perform various activities of daily living by himself.

5th December, 2020

6. Patient’s sleep pattern will return to normal within 24 hours as evidenced by;

a. Patient verbalizing, he was able to sleep uninterrupted throughout the night.

b. Nurse observing patient sleep for about 6-8 hours uninterrupted throughout the

night.

6th December, 2020

7. Patient will be relieved of anxiety within 6 hours as evidenced by;

a. Patient verbalizing, he no longer feels anxious.

b. Nurse observing patient in a cheerful mood.

NURSING CARE PLAN

The nursing care plan is a written summary of the total care a client is to receive which is

often individualized
 Table 4. BELOW TABLE IS CARE PLAN DRAWN FOR CHILD. B.K.N
DATE/ NURSING OBJECTIVE/OUTCOME NURSING NURSING EVALUATION
TIME DIAGNOSE CRITERIA ORDERS INTERVENTIONS
S
02/12/20 Acute pain Patient left leg pain will be 1.Reassure patient 1.Patient was reassured of Goal fully met as:
@ (left leg) reduced within 2 hours as competent nursing care a. Patient verbalized a
8:55am related to evidenced by: 2.Assess patient’s level of 2.Patient’s pain level was reduction in left leg
intravascular a. Patient verbalising a pain assessed using a numerical pain joint pain with a pain
occlusion. reduction in pain scale with a pain rating of 3. rating of 3 on a
with the pain 3.Assist patient to assume a 3.Patient was assisted to assume numeric pain scale
reduced from 8 to 3 comfortable position a supine position b. Nurse observing
using a numeric 4.Apply warm compress to the 4.Warm compresses was applied patient has a calm
pain scale. site of pain. to the left leg joint to relieve and relaxed facial
b. Nurse observing pain. expression in bed.
patient has a calm 5. Engage the patient in 5.Patient was engaged in
and relaxed facial diversional therapy. conversation to help him forget 02/12/2020
expression in bed. his pain. @
6. Encourage fluid intake 6. Patient was encouraged to 10:55am
take in water most often
7.Administer prescribed 7. IV Paracetamol 100mg stat
analgesic. was administered to relieve pain.
8. Set up infusions 8. IV normal saline 1L set up.
DATE/ NURSING OBJECTIVE/OUTCOME NURSING NURSING EVALUATION
TIME DIAGNOSE CRITERIA ORDERS INTERVENTIONS
S
02/12/20 Hyperthermia Patient body temperature 1.Reassure patient 1.Patient was reassured of Goal fully met as:
@ (above will be reduced within 1 competent care. a. Nurse checking
11:00am normal, 38.1 hour as evidenced by patient body
degrees a. Patient verbalizing 2.Monitor vital 2.Temperature was checked and temperature to ensure
Celsius) that his body is no signs(temperature) recorded every 30 minutes until that it has reduced to
related to longer warm to it dropped from 38.1 degree 37.2 degree Celsius.
increased touch. Celsius to 37.2 degree Celsius b. Patient body was no
metabolic b. Nurse checking longer warm to touch.
rate. patient vital signs 3.Tepid sponge patient when 3.Patient was tepid sponge with
especially necessary lukewarm water to reduce the 02/12/20
temperature to temperature. @
ensure that it has 12:00pm
reduced. 4.Open nearby windows. 4.Nearby windows were opened
to allow air into room

5. Serve prescribed antipyretic 5.Prescribed antipyretic was

drug. served.
DATE/ NURSING OBJECTIVE/OUTCOME NURSING NURSING EVALUATION
TIME DIAGNOSE CRITERIA ORDERS INTERVENTIONS
S
02/12/20 Headache Patient’s headache will be 1.Reassure patient 1. Patient was reassured of Goal fully met as:
@ related to reduced within 1 hour as competent nursing care. a. Patient verbalising a
12:10pm reduced blood evidenced by; reduction in pain in
flow to the a. Patient verbalising a 2. Assess pain level, 2. Pain level was assessed with a the head with a pain
brain. reduction in pain in characteristics and numeric pain scale; pain was rating of 3
the head with a pain precipitating factors. moderate with a reading of 5/10 b. Nurse observed
rating of 3 and located at the frontal part of patient to have a calm
b. Nurse observe the head. and relaxed facial
patient has a calm expression in bed.
and relaxed facial 3. Assist patient to assume a 3.Patient was assisted to assume
expression in bed comfortable position. a supine position. 02/12/2020
@
4. Monitor vital signs and 4.Patient vital signs was checked 1:10pm
record. and recorded to ensure it fell
within the normal ranges.

5. Serve prescribed analgesic 5.Prescribed analgesic was

served.
DATE/ NURSING OBJECTIVE/OUTCOME NURSING NURSING EVALUATION
TIME DIAGNOSE CRITERIA ORDERS INTERVENTIONS
S
03/12/20 Risk for Patient will remain free from 1.Reassure patient 1.Patient was reassured of Goal partially met as:
@ Imbalanced nutritional imbalances within competent nursing care to restore a. Patient maintained weight on
1:00pm nutrition (less 48 hours as evidenced by; his appetite admission.
than body a. Patient maintaining 2. Plan diet with patient, family 2. Patient’s diet was planned with
requirement) his weight on and nutritionist. his so that he could choose his b. Nurse observed patient
related to admission (25kg). preferred food consume less than half of
inadequate food 3. Provide good oral hygiene 3. Patient was assisted with oral nutritious meal served.
intake b. Nurse observing hygiene to promote his appetite

secondary to patient consume more 05/12/20

4. All nauseating items like bedpan
bitter taste in than half of nutritious 4.Remove all nauseating items. was removed from patient’s @
the mouth meal served. environment to promote good 1:00pm
appetite

5.Serve patient with favourite

5.Patient’s favourite food; Banku
food. and Okro stew was served in bits
and attractive manner to facilitate
eating

6.Congratulate patient and 6.Patient was congratulated on his

effort made during mealtime to
document care
boost his confidence. All nursing
 care was duly documented
DATE/ NURSING OBJECTIVE/OUTCOME NURSING NURSING EVALUATION
TIME DIAGNOSE CRITERIA ORDERS INTERVENTIONS
S
04/12/20 Activity Patient will be able to perform 1.Reassure patient 1.Patient was reassured of Goal fully met as:
@ intolerance activities of daily living within competent nursing care 1.Patient verbalized ability to
1:30pm related to 48 hours as evidenced by; 2.Assist patient in performing 2.Patient was assisted in perform perform activities of daily
general body a. Patient verbalising activities of daily living activities of daily living such as living.
weakness. ability to perform bathing, oral care and eating 2.Nurse observed patient
activities of daily 3. Place patient’s items within 3.Patient’s items were placed within performed activities of daily
living. his reach his reach. living by himself.
b. Nurse observe patient
perform various 4. Ensure adequate bed rest and 4.Adequate bed rest and sleep was 06/12/20
activities of daily sleep ensured as less visitors were @
living by himself allowed in and were allowed only 1:30pm
during visiting hours.

5. Practice bulk nursing and 5.Patient was informed to call for

inform patient to call for assistance and bulk nursing was
assistance practiced.

6. Encourage patient to eat well 6.Patient was encouraged to eat lots

and drink more water. of fruits and vegetables and drink at
 most 3 litres of water daily.
DATE/ NURSING OBJECTIVE/OUTCOME NURSING NURSING EVALUATION
TIME DIAGNOSE CRITERIA ORDERS INTERVENTIONS
S
05/12/20 Insomnia Patient’s sleep pattern will 1. Reassure patient 1.Patient was reassured of Goal fully met as:
@ related to return to normal within 24 competent nursing care to a. Patient verbalized he
3:00pm unfamiliar hours as evidenced by; improve his condition. was able to sleep well
ward a. Patient verbalising, throughout the night.
environment he was able to sleep 2.Practice bulk nursing 2.Bulk nursing was adopted to
well throughout the reduce stimulation. b. Nurse observed
night. patient sleep for
b. Nurse observing 3.Limit the number of visitors 3. Patient’s parents were the only about 6-8 hours
patient sleep for people allowed to visit patient uninterrupted
about 6-8 hours during visiting hours. throughout the night.
uninterrupted 06/12/20
throughout the 4.Ensure that the environment 4.Patient’s environment was free @
night. is serene and change soiled from noise and soiled bed linen 3:00pm
bed linen. was change.

DATE/ NURSING OBJECTIVE/OUTCOME NURSING NURSING EVALUATION

 TIME DIAGNOSE CRITERIA ORDERS INTERVENTIONS
S
06/12/20 Anxiety Patient will be relieved of 1.Reassure patient 1.Patient and family were Goal fully met as:
@ related to anxiety within 6 hours as reassured of competent nursing 1. Patient verbalized he no
care that would help to relieve
11:00am hospitalisation evidenced by; longer felt anxious.
patient’s pain and improve his
a. Patient verbalising, current condition 2. Nurse observed patient
he no longer feels was in a cheerful mood.
2. Assess patient and family’s 2.Patient and family’s level of
anxious.
level of anxiety anxiety was assessed through
b. Nurse observing questioning 06/12/20
patient in a @
3.Explain all procedures to 3.All procedures were explained
cheerfully mood 5:00pm
patient and family. to patient and family using
simple language to allay anxiety

4. Provide massage and 4.Patient was given therapeutic

backrub to allay anxiety massage and given backrubs to
allay anxiety.